: The scientific literature offers little information about the use of stimulants, particularly methamphetamine ("meth"), cocaine, and crack, in rural America. We know little about the characteristics of rural stimulant users, how stimulant use is organized, the course of stimulant use, or about drug treatment and other service use in rural areas. Rural characteristics suggest that inferences from urban drug users may not be generalizable to rural stimulant users. Recently, Wright State University (WSU) in Dayton, Ohio was funded by NIDA to study rural Ohio stimulant users, and to identify factors associated with their drug use and use of health services. This application proposes to expand and enhance the Ohio rural stimulant research to the Arkansas Mississippi Delta and Appalachian Kentucky, by contributing a substantially wider range of rural ecologies, participant demographic and cultural characteristics, service availability, and service use. We will expand the primary focus of the Ohio study to a broader-based natural history of rural stimulant use and health services, highlighting the critical role of co-occurring mental disorders in relationship to trajectories of drug use and use of health services, including mental health services. We will also target interactions with the criminal justice system as longitudinal measures. We propose to develop complementary projects using parallel specific aims and procedures, and common data collection instruments, with the Ohio project. We will study 450 stimulant users over a three-year interval with six-monthly follow-ups. Using both qualitative and quantitative methods, our overall specific aim is to characterize stimulant use and use of health services in two distinct rural ecologies. We plan to study the longitudinal course of drug use and predictors of drug use, and use of treatment, mental health, general medical, and ER services, and to conduct pooled analyses of the Arkansas, Kentucky, and Ohio samples. This expanded research from three diverse rural ecologies will provide convincing and cogent data for health planning and health policy for prevention and treatment of stimulant users in rural areas.